Metastatic Ewing Sarcoma Research Articles

The effect of total parenteral nutrition on chemotherapy-induced myelosuppression: A randomized study

We studied the effect of total parenteral nutrition on recovery from myelosuppression in patients receiving intensive chemotherapy. Twenty-seven patients (ages 11 to 33 years) with locally recurrent or metastatic Ewing's sarcoma, rhabdomyosarcoma, or osteosarcoma were randomly selected to receive either conventional oral nutrition or total parenteral nutrition concurrently with intensive chemotherapy. The control group (15 patients) received significantly fewer calories (range 380 to 880/m 2 per day, median 685 versus range 1,020 to 2,100, median 1,650) and less nitrogen (0–3.7 g/m 2 per day, median 1.5 versus range 5.3 to 12.4, median 8.9) than the group receiving total parenteral nutrition (12 patients). Asessment of recovery from myelosuppression was based on the length of time the absolute granulocyte count was below 500/mm 3, the length of time the platelet count was below 40,000/mm 3, the number of days the platelet count was below 20,000/mm 3, and the number of blood transfusions required. There was no statistical difference in any of the parameters evaluated between the group that received total parenteral nutrition and the control group (p > 0.05); granulocyte and platelet recovery and the difference in transfusion requirement favored the control group with marginal statistical significance (p = 0.05). The frequency of clinical infections was similar in the patients receiving total parenteral nutrition (five of 12) and in those receiving conventional oral nutrition (five of 15). Thus, although total parenteral nutrition could be safely administered in this severely myelosuppressed population, no benefit could be defined in recovery from bone marrow suppression or frequency of clinical infections.

Sequential half-body irradiation as systemic treatment of progressive ewing sarcoma

Sequential half-body irradiation (HBI) to be delivered in two sessions was used in 18 consecutive patients with metastatic Ewing sarcoma who relapsed after radiotherapy and multidrug chemotherapy. The HBI program to both upper and lower hemi body was completed in 11 patients (61 %). The remaining 7 patients received only one single treatment of HBI because of relapse before the completion of the treatment program. In 20 of the 29 sessions HBI was employed to treat overt metastases. The overall objective response rate was 50 %. Six of 18 patients (33 % ) are alive from 4 to 27 months, 3 of them without evidence of disease. No severe toxicity was observed. HBI as systemic treatment was more effective in patients who relapsed while off chemotherapy, with metastases confined to the lungs or to one single bone segment.

Half-body irradiation (HBI) in the treatment of metastatic Ewing's sarcoma resistent to chemotherapy: [formula omitted], [formula omitted], [formula omitted], [formula omitted], [formula omitted]. Istituto Nazionale per lo Studio e la Cura dei Tumori, 20133 Milan, Italy

Half-body irradiation (HBI) in the treatment of metastatic Ewing's sarcoma resistent to chemotherapy: [formula omitted], [formula omitted], [formula omitted], [formula omitted], [formula omitted]. Istituto Nazionale per lo Studio e la Cura dei Tumori, 20133 Milan, Italy

Radiotherapy and combination chemotherapy in advanced Ewing's Sarcoma-Intergroup study.

Forty-four patients with metastatic (36 patients) and advanced regional (eight patients) Ewing's sarcoma were treated on a protocol employing intensive combination chemotherapy and radiotherapy to all sites of overt disease (primary site and metastatic sites). Thirty-one patients achieved a complete remission, eight achieved a partial remission, and five patients did not respond to treatment. Of the 31 patients who achieved a complete remission (12 had metastases and six had regional spread), 18 remained disease-free with a median follow-up of 34 months, while recurrences occurred in nine patients. Four patients died of complications of treatment. Although late relapses can still be expected, it appears that intensive multimodal management in metastatic Ewing's sarcoma can produce prolonged disease-free survival and possibly cure in a significant percentage of patients.

Ewing sarcoma: its course and treatment in 50 adult patients.

34 patients were treated for Ewing sarcoma with primary presentation. There were 10 females and 24 males with average age of 21 years (range 16-36 years). These patients received radiotherapy (greater than 5,000 R) to the primary site and combination chemotherapy with vincristine, cyclo-hosphamide, doxorubicin and actinomycin D. Of 19 patients with primary presentation in an extremity, 12 remain alive at 29 months without clinical evidence of tumor (63%); 2 patients are alive with relapse. All 10 patients with primary presentation in the pelvis died despite vigorous treatment. 3 patients are alive out of 5 patients with primary presentation in chest or abdominal wall or axilla but only 1 patient remained tumor-free. Of the entire group of 34 patients, 12 remained tumor-free at 27 months (35%). 2 relapsed patients were rendered surgically tumor-free and receive further treatment. 20 patients died or are receiving treatment for advancing disease. 16 patients were treated for locally recurrent (1 patient) or metastatic (15 patients) Ewing sarcoma. There were 6 females and 10 males (average age 24.7 years). These patients received palliative radiotherapy and combination chemotherapy with vincristine, cyclophosphamide, doxorubicin, actinomycin D and dacarbazine. At 36 months, 3 patients are alive tumor-free and 1 patient is alive with stable disease. 12 patients died, 2 after temporarily achieving complete remission.

Radiotherapy and combination chemotherapy in metastatic Ewing's Sarcoma — intergroup study

Radiotherapy and combination chemotherapy in metastatic Ewing's Sarcoma — intergroup study

Desacetyl vinblastine amide sulfate induced ineffective erythropoiesis

Ineffective erythropoiesis occurred during desacetyl vinblastine amide sulfate (VDS) therapy of a patient with metastatic Ewing's sarcoma. The peripheral blood was characterized by anisocytosis, poikilocytosis and reticulocytopenia. Bone marrow showed megaloblastic red cell hyperplasia with nuclear fragmentation, binuclearity and abnormal metaphases. Radioiron incorporation into red cells was markedly decreased. Electron microscopy showed red cell surface changes previously called ropalocytosis. Normal erythropoiesis promptly resumed when VDS treatment was withheld. Although less common than leukopenia, red cell abnormalities are part of the spectrum of vinca alkaloid toxicity.

Mithramycin in the treatment of metastatic ewing's sarcoma

Five patients with progressive, metastatic Ewing's sarcoma were treated with infusions of mithramycin. Two had excellent regressions of their tumors; one patient has no clinical evidence of tumor more than 7 years after mithramycin was given. Patients who are resistant to cyclophosphamide may respond to mithramycin and vice versa. The exact role of mithramycin in patients with Ewing's sarcoma is not known. Further experimental trials are indicated with mithramycin alone and in combination both as adjunctive therapy and for the treatment of metastatic disease.

Treatment of metastatic Ewing's sarcoma with BCNU.

Treatment of metastatic Ewing's sarcoma with BCNU.

Cyclophosphamide in the management of Ewing's sarcoma.

The activity of alkylating agents, cyclophosphamide and melphalan, was studied in 13 patients with metastatic Ewing's sarcoma. A total of 15 courses of melphalan was administered to five patients at a dose of 1.0 to 1.5 mg/kg per course. There were no responses. Cyclophosphamide was administered to 11 patients, including three melphalan failures. Five partial and two complete responses were obtained, two of whom were melphalan failures. An intermittent intravenous schedule of 15 mg/kg once weekly was convenient and effective, resulting in five of the seven responses. The direct intrapleural instillation of two doses of 15 mg/kg produced total control of pleural effusion in one patient. Only one of four patients on a daily oral schedule of 5.0 mg/kg demonstrated a partial response. The mean dose to response was 45 mg/kg, and the mean duration of response was 5+ months. Factors adversely affecting responsiveness are short-duration of disease prior to initiation of chemotherapy and a “symptom status” indicating marked disability from disease. Severe vomiting, noted in four of the seven patients receiving parenteral therapy and one of the four on oral therapy, was the most disabling side reaction. Ewing's sarcoma should be considered a cyclophosphamide-responsive neoplasm in the same category as neuroblastoma and malignant lymphoma.